Fillable Form 2022: 2021-2022 ELECTRICAL APPRENTICE TRAINING (Electrical Association)

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Form 2022: 2021-2022 ELECTRICAL APPRENTICE TRAINING (Electrical Association)

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Electrical Association
3100 Humboldt Ave S • Mpls, MN 55408
Ph: (612) 827-6117 • Fax: (612) 827-0920
www.electricalassociation.com
2021-2022 ELECTRICAL APPRENTICE TRAINING
Start Date: September 21, 2021
End Date:
April
26,
2022
Time: 6:30-9:30pm (CT)
EARLY-BIRD DISCOUNT!
Save $50 - Register before July 9
Save $25 - Register before July 30
Check the year you are
registering for Part 1: TUITION & FEES Member Nonmember Amount
Y1
Y2
Y3
Y4 Tuition (deduct the Early-Bird discount if applicable) $1230 $1450
Test-Out Fee:
I wish to test out of: Y1 Y2 Y3
Fee for testing out (applied to tuition upon enrollment)
*Discuss this option with your employer to ensure that
you are meeting all necessary req’ts by testing out. Testing
out may not be equivalent to 144 hrs of class time.
$100/yr $100/yr
Late Fee:
Late Fee after Sept 14. (Late registrants will not receive
books or login information in time for the rst class!)
$150 $150
Tuition & Fees Total:
Required Books:
Y1 Y2 Y3 Y4 Part 2: BOOKS
Semester 1 Study Guide $72.50 $82.50
Semester 2 Study Guide $72.50 $82.50
2020 NEC
®
Code Book and EZ Tabs™ $109 $112
Standard Textbook of Electricity (7
th
ed) $150 $170
Electrical Grounding & Bonding (5
th
ed) $80 $90
Electric Motors‒Theory, Controls & Installation $110 $120
Optional (Y3, Y4 content): Electrical Wiring Commercial (17
th
ed) $110 $120
Optional (all years): 2020 Ugly’s Electrical Reference $15 $16
Books:
Shipping:
(add 6% of books)
Handling: $10
Subtotal:
Sales Tax on Subtotal:
(MN residents only—
add 6.875%)
Books Total:
TOTAL AMOUNT DUE (add Tuition & Fees and Books totals) $ _________________
*Prices are subject to change without notice.
Check Enclosed Credit Card (Visa, MC, Discover)
CC # ____________________________________ Exp: _______ CV2: _________
Name on Card: ________________________________________________________
Billing Address: ________________________________________________________
Student Name: _____________________________________
Cell Ph: __________________________________________
Address: _________________________________________ MN DLI Unlicensed Registered #: _____________________
(MN residents only)
City, State, Zip: ____________________________________ Student Email: ____________________________________
Ship my books to: Company Student
Company Name: ___________________________________ Business Ph: _____________________________________
Address: _________________________________________ Apprentice Admin: _________________________________
City, State, Zip: ____________________________________ Admin Email: _____________________________________
Please complete the Release of Grades Waiver with your registration form and return:
Email: info@electricalassociation.com • Fax: 612-827-0920
APPRENTICE INFORMATION
Name of Apprentice: ________________________________________________________
Address: _________________________________________________________________
City, State, Zip: ____________________________________________________________
Email Address (required): ____________________________________________________
Cell Phone: _______________________________________________________________
COMPANY INFORMATION
Company Name: __________________________________________________________
Company Address: ________________________________________________________
City, State, Zip: ___________________________________________________________
Name of Apprentice’s Administrator: __________________________________________
Email of Apprentices’s Administrator: __________________________________________
Phone of Apprentice’s Administrator: __________________________________________
RELEASE WAIVER & AUTHORIZATION
I hereby authorize the Electrical Association to release all information in regard to
this training to the electrical contractor/apprentice administrator listed above. This
waiver remains valid for my entire enrollment in the apprentice program.
Apprentice Signature: ______________________________________________________
Date: ___________________________________________________________________
I DO NOT wish to release information (sign below)
Apprentice Signature: ______________________________________________________
Date:
______________________________________________________________
Please return this Release of Grades Waiver with your registration form:
Email: info@electricalassociation.com • Fax: 612-827-0920
STUDENT WAIVER
FOR RELEASE OF GRADES
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Form 2022: 2021-2022 ELECTRICAL APPRENTICE TRAINING (Electrical Association)

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Completed 17 July 2021

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